Children are our nation's most precious resource because of the change in the old age dependency ratio – the number of active working age adults per pensioner. In 1971, the ratio was 3.6; it fell to 3.2 in 2008, and it could fall to 2.0 within 35 years.

We need healthy, educated, creative and resilient children to become the productive adults supporting an aging population, so investing in them should be a top national priority. But they are also citizens today deserving all the entitlements that follow, including the 42 Articles of the UNCRC.

Is all well for children, childhood and child health now as we experience unprecedented political turbulence, austerity, increasing poverty and ideological reforms of health and education?

There has been much progress. Children, generally, are healthy and few die through improved diagnosis, treatment and effective immunisation. New children’s hospitals and wards for adolescents have improved the culture of services.

Despite this, all is not well for too many of our children with many outcomes in health, education, youth justice and social care falling below other developed nations.

Why so many of our children are faring so poorly is an uncomfortable question demanding analysis and action.

The British Medical Association in its report ‘Growing up in the UK’ analysed government policy on child health, concluding that ‘Politicians have been failing children on a grand scale’, by not implement the Children’s NSF, dismantling the Every Child Matters policy, and failing to provide adequate resources. Over 1600 children die each year because services are below the quality of other European countries; there are poor outcomes for even common conditions such as asthma and epilepsy, inadequate services for children with mental ill health (with less than 25% being able to access the services they need) and disabilities. Looked after children fare particularly poorly.

The CMO for England in her annual report in 2013 comments that ‘we should be profoundly ashamed of our record on child health’ - that such a senior government official should challenge the state of child health is unprecedented.

The independent Children’s Outcomes Forum in its first annual report for 2013/14 challenges politicians and the child health professionals in how services for children and young people are delivered. It highlights the difficulty in getting an overview of what is happening and how performance management is being undertaken nationally and locally, and lists areas where progress has been slow or has stalled.

The lack of accountability at national as well as local level and of coherent data systems to link and track outcomes are challenged yet again.

The ongoing failure to ensure that children and young people are treated in age appropriate settings is re-exposed, alongside poor participation of children and young people in informing policy and service delivery.  Improved transparency by Clinical Commissioning Groups is needed to ensure that contracts include outcomes and not just targets or inputs.

Better integration is needed between health and education to improve resilience through better attachment, parenting and mental health. The plight of children with complex health and care needs including those with life limiting conditions and disability are highlighted once more.

Twenty or more years of endlessly reiterated political rhetoric have undoubtedly led to improvements, but much more must be done to allow all our children to have the quality of life seen in other developed nations. No further reports are required – the evidence for what needs to be done is there!

We need cross-partypolitical will to see children as a vital priority and as citizens in their own right; an explicit commitment especially for the most vulnerable; an intellectual framework for an overall policy with responsibility for all aspects of policy affecting children integrated across Government; a coherent vision for the long term driven by standards, objectives and measured outcomes coupled with appropriate resources and an accountable framework for delivery.

Professions in child life must be more effective advocates for children’s health, including a manifesto and score card against which politicians should be held to account.The proposed creation of a Foundation of Child Health by the RCPCH provides an outstanding opportunity for effective leadership and political advocacy alongside sharing best practice UK-wide.

Political focus for children is ephemeral, short term, inconsistent and untrustworthy, so has the time not come for local civil society to take responsibility for its children by developing communities with resilient children at their hearts?

In Canada, the Human Early Learning Partnership is driving effective change for children through understanding the local context by ‘mapping’ from routine data its demography, inputs, outputs, outcomes and ‘nurturative assets’, and the ‘Strive Together’ initiative in Cincinnati shows what can be done by developing effective local partnerships.

New freedoms for Public Health provide important opportunities to develop the ‘It Takes a Village’ model here. Understanding the local population, addressing standards as well as outcomes, improvinginter-professional practice through breaking down the bunkers between health, education, social care and the third sector, a locally owned strategy with accountable responsibility driven by defined objectives and metrics in partnership with children and families are the components that could transform children’s lives. Effective leadership is vital. Let’s celebrate what’s good - but we cannot afford to continue to fail so many children. 

Professor Sir Al Aynsley-Green
Professor Emeritus of Child Health, University College London;
Founder, Aynsley-Green Consulting
Salisbury SP28LE
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